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Confidential to RBH and RBCBSOEntire contents © 2005 RBH All rights reserved
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PEBB Behavioral Health Services Management Report
Reliant Behavioral HealthJanuary, 2005
PEBB Behavioral Health Management Report BD attach. 8
Confidential to RBH and RBCBSOEntire contents © 2005 RBH All rights reserved
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Presentation Outline:
1. A brief review RBH services on behalf of PEBB and its members and the prevalence of conditions for which PEBB members have been treated
2. Focus on the effects of the enhanced PEBB “parity” benefit
PEBB Behavioral Health Management Report BD attach. 8
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Part 1: Review of RBH Services. Report on Prevalence of Behavioral Health Conditions.
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Utilization Management – Pre-authorization, concurrent and retrospective review for inpatient and residential levels of care. Treatment plan review for outpatient care.
Case Management – Coordination of care for identified members with concurrent physical and behavioral disorders and/or complex/chronic behavioral health conditions (coordinated with Regence BCBSO).
Provider Relations – Effect response to provider inquiries, service and claims adjudication, etc.
Support Services for RBCBSO – Assistance to RBCBSO Customer Service for appropriate referral of PEBB members seeking specific behavioral health services.
Review of Current RBH Services
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Unique Considerations in Behavioral Health Care Management
With fewer Catastrophic Cases, successful management focuses on broad utilization activities across large segments of population (e.g. treatment plan review)
Processes are sequential and iterative – with continual contacts with providers (rather than a single contact to set
length of treatment)
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Prevalence of Behavioral Health Disorders in PEBB MembersNew Trends in 2003
PEBB Behavioral Health Management Report
Inpatient Care – Increase in Adult Alcohol and Substance Dependence Care
Residential Care – Increase in Adolescent Mental Health and Substance Dependence Care. Increase in treatment of Anorexia and ADHD
Outpatient Care – Overall increase in members seeking care (penetration). Increasing effectiveness of treatment plan review
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Part 2: The Effect of Parity
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Previous implementation of unlimited Alcohol and Substance Dependence benefits in January 2001
Implementation of new Mental Health benefits in January 2003: unlimited Inpatient and Outpatient benefit, Residential benefit increases to 45 days/year (from 19 days/24 months)
Implementation of RBH services in January 2003
Background
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Optimizing the Effect of the new PEBB Benefit: The Best of Both Worlds
PEBB Behavioral Health Management Report
New benefit levels should assure that all members with conditions who require “enhanced treatment” (treatment beyond what was previously covered under benefits) would now receive coverage for the care truly required to meet their needs.
The new Behavioral Health management services should promote appropriate care across all members receiving treatment, reducing non-Medically Necessary treatment
and improving coordination of care.
The best of both worlds should be enhanced care for those requiring it, with overall cost increased mitigated by effective care management.
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Review of Care delivered to PEBB Members beyond what was previously covered under benefits
PEBB Behavioral Health Management Report
Previous Regence BCBSO Reports have noted utilization of parity “pool” supporting enhanced treatment for appropriate PEBB members.
RBH Reports note that by diagnosis, members suffering from Major Depression, Bipolar Disorder,
and Anorexia can be identified as primarily benefited by the enhanced benefit.
Adolescents members in particular were benefited by the enhanced residential benefit.
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Page 11PEBB Behavioral Health Management Report
Appropriate Care Management should reduce non-Medically Necessary treatment, improving coordination of care and mitigating claims costs
Unadjusted 2003 Behavioral Health Claims increased 20.5% (.87% increase in total medical claims)
Adjusted 2003 Behavioral Health Claims increased 6.4% (.27% increase in total medical claims)
Trends for 2004 show further mitigation of the effect of the new benefit levels as Utilization Management “ramps up”
Managed Parity data compares very favorably with national SAMHSA projections
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• The impact of increases in reimbursement rates and penetration rates are independent of the behavioral health benefit.
• Utilization Trends (increase in days/sessions per incident of care) are affected by the new benefit levels – and also are affected by appropriate Utilization Management.
Influences on Claims Cost
ClaimsCost
ReimbursementRates Penetration
New BenefitLevels
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Summary - the Effect of Parity
“The overall picture is very positive. Members with conditions which require ‘enhanced treatment’ are receiving the care appropriate to meet their needs. Total member satisfaction with behavioral health services remains high. And increasingly, the effect of overall Utilization Management is moderating claims costs.
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